Individual
TIFFANY JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HIS
Contact information
Practice address
1130 BICHARA BLVD, LADY LAKE, FL 32159-7716
(352) 750-4327
(352) 750-2410
Mailing address
750 N COMMONS DR STE 200, AURORA, IL 60504-7940
(630) 303-5380
(630) 303-5385
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
AS4900
FL
Other
Enumeration date
09/04/2013
Last updated
05/13/2021
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